COMLEX-USA Surgery and Emergency Medicine 2

Question 1

Which is the most common cause of small bowel obstruction in adults in the United States?

Accepted Answer

Adhesions from prior surgery

Answer

Adhesions from prior abdominal surgery account for approximately 60–75% of small bowel obstructions in adults.

Question 2

A trauma patient has absent breath sounds on the left, hypotension, and tracheal deviation to the right. Immediate action is:

Accepted Answer

Needle decompression of the left chest

Answer

Tension pneumothorax (absent breath sounds, hypotension, tracheal deviation away from the affected side) is a clinical diagnosis requiring immediate needle decompression.

Question 3

Which condition presents with colicky flank pain radiating to the groin, hematuria, and nausea — often described as the worst pain of the patient's life?

Accepted Answer

Ureterolithiasis (renal/ureteral stone)

Answer

Ureteral colic from a kidney stone causes severe colicky flank-to-groin pain, hematuria, and nausea due to ureteral obstruction and spasm.

Question 4

A patient develops fever, purulent wound discharge, and erythema on post-op day 5 from an appendectomy. The most likely cause is:

Accepted Answer

Wound infection

Answer

Wound infection typically presents 3–7 days after surgery with fever, erythema, warmth, and purulent discharge at the incision site.

Question 5

In acute cholecystitis, which physical exam finding is pain with palpation of the RUQ that increases with inspiration?

Accepted Answer

Murphy's sign

Answer

Murphy's sign is cessation of inspiration due to pain when the examiner presses the RUQ and the inflamed gallbladder descends to meet the fingers.

COMLEX-USA Practice Test

COMLEX-USA Practice Test

COMLEX-USA Surgery and Emergency Medicine 2